Conflict-free Case Management System Design

Agnew::Beck and Home and Community Based Strategies (HCBS) developed a system redesign to comply with new Centers for Medicare & Medicaid Services (CMS) regulations for conflict-free case management. Alaska was funding its Medicaid-funded Home and Community-Based Services (HCBS) Waivers under the 1915(c) waiver authority. CMS published final rules that became effective in March 2014 that affected these waivers. In order to make recommendations for implementation, this project was on an accelerated two-month timeframe. Over ten stakeholder interviews were conducted in preparation for a two-day workshop with over 40 provider and state organizations attending. Our team presented factual information on the new CMS regulations and insight into how other states are meeting the requirements for conflict-free case management. We facilitated small and large group discussions to identify the most effective way to redesign case management to meet the new requirements. The new CMS regulations fundamentally changed the way providers serve recipients resulting in many stakeholders having strong and emotional opinions about the outcome of the process. Through the two-day work session and a follow-up half-day meeting, we developed consensus where possible and documented areas of continued disagreement. Realistic options for meeting the CMS requirements, that make sense for Alaska, were developed into a clear and concise final report that contained background information, options for compliance, and short and long-term activities with estimated timelines.